scholarly journals The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study

2018 ◽  
Vol 6 (20) ◽  
pp. 1-200 ◽  
Author(s):  
Helen Atherton ◽  
Heather Brant ◽  
Sue Ziebland ◽  
Annemieke Bikker ◽  
John Campbell ◽  
...  
Keyword(s):  
General Practice ◽  
Face To Face ◽  
Mixed Methods Case Study ◽  
The Face ◽  
Patient Groups ◽  
General Practices ◽  
Future Evaluation ◽  
The Impact ◽  
E Mail

BackgroundThere is international interest in the potential role of different forms of communication technology to provide an alternative to face-to-face consultations in health care. There has been considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or internet video. However, little is understood about how, under what conditions, for which patients and in what ways these approaches may offer benefits to patients and practitioners in general practice.ObjectivesOur objectives were to review existing evidence about alternatives to face-to-face consultation; conduct a scoping exercise to identify the ways in which general practices currently provide these alternatives; recruit eight general practices as case studies for focused ethnographic research, exploring how practice context, patient characteristics, type of technology and the purpose of the consultation interact to determine the impact of these alternatives; and synthesise the findings in order to develop a website resource about the implementation of alternatives to face-to-face consultations and a framework for subsequent evaluation.DesignMixed-methods case study.SettingGeneral practices in England and Scotland with varied experience of implementing alternatives to face-to-face consultations.ParticipantsPatients and practice staff.InterventionsAlternatives to face-to-face consultations include telephone consultations, e-mail, e-consultations and internet video.Main outcome measuresHow context influenced the implementation and impact of alternatives to the face-to-face consultation; the rationale for practices to introduce alternatives; the use of different forms of consultation by different patient groups; and the intended benefits/outcomes.Review methodsThe conceptual review used an approach informed by realist review, a method for synthesising research evidence regarding complex interventions.ResultsAlternatives to the face-to-face consultation are not in mainstream use in general practice, with low uptake in our case study practices. We identified the underlying rationales for the use of these alternatives and have shown that different stakeholders have different perspectives on what they hope to achieve through the use of alternatives to the face-to-face consultation. Through the observation of real-life use of different forms of alternative, we have a clearer understanding of how, under what circumstances and for which patients alternatives might have a range of intended benefits and potential unintended adverse consequences. We have also developed a framework for future evaluation.LimitationsThe low uptake of alternatives to the face-to-face consultation means that our research participants might be deemed to be early adopters. The case study approach provides an in-depth examination of a small number of sites, each using alternatives in different ways. The findings are therefore hypothesis-generating, rather than hypothesis-testing.ConclusionsThe current low uptake of alternatives, lack of clarity about purpose and limited evidence of benefit may be at odds with current policy, which encourages the use of alternatives. We have highlighted key issues for practices and policy-makers to consider and have made recommendations about priorities for further research to be conducted, before or alongside the future roll-out of alternatives to the face-to-face consultation, such as telephone consulting, e-consultation, e-mail and video consulting.Future workWe have synthesised our findings to develop a framework and recommendations about future evaluation of the use of alternatives to face-to-face consultations.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Alternatives to the face-to-face consultation in general practice: focused ethnographic case study

2018 ◽  
Vol 68 (669) ◽  
pp. e293-e300 ◽  
Author(s):  
Helen Atherton ◽  
Heather Brant ◽  
Sue Ziebland ◽  
Annemieke Bikker ◽  
John Campbell ◽  
...  
Keyword(s):  
General Practice ◽  
Participant Observation ◽  
Health Issues ◽  
Ethnographic Case Study ◽  
Structured Interviews ◽  
Face To Face ◽  
The Face ◽  
General Practices ◽  
The One

BackgroundNHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives.AimTo understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice.Design and settingFocused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016.MethodNon-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the ‘one sheet of paper’ mind-map method to identify the line of argument in each thematic report.ResultsCase study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other’s practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal.ConclusionExperience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team.

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

scholarly journals The Role of Responsive Leadership in Meeting Customers' Needs during Crises

2022 ◽  
Vol 13 (1) ◽  
pp. 0-0
Keyword(s):  
Large Scale ◽  
Education Institution ◽  
Face To Face ◽  
Leadership Attributes ◽  
Leadership Support ◽  
The Face ◽  
Quantitative Results ◽  
The Impact

This case study conducted to investigate the impact of a responsive leadership approach in meeting customers' needs in a higher education institution in the UAE during the COVID-19 pandemic. For this purpose, a mixed-method model has been used. The data has been collected from a convenient sample working and studying at Al Qasimia University Language Center, in fall 2020. This result indicates that the provided responsive leadership support during COVID-19 was effective and helped in motivating learners and customers to keep learning and making progress greater than what was shown before COVID-19, during the face-to-face teaching and physical assessment. Although the qualitative and quantitative results in this case study revealed a significant impact of responsive leadership approach on customers’ progress, there is still a need to conduct other researches to develop and validate a responsive leadership inventory to facilitate measuring of responsive leadership attributes in a large scale sample and/or population.

scholarly journals 1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Jegatheeswaran ◽  
B Choi ◽  
M F Rocha ◽  
A Green
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Face To Face ◽  
Retrospective Audit ◽  
Nice Guidance ◽  
Ear Wax ◽  
The Face ◽  
The Impact

Abstract Aim The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals. Method An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020. Results In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November. Conclusions Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.

scholarly journals Experiences with online consultation systems in primary care: case study of one early adopter site

2017 ◽  
Vol 67 (664) ◽  
pp. e736-e743 ◽  
Author(s):  
Michael Casey ◽  
Sara Shaw ◽  
Deborah Swinglehurst
Keyword(s):  
General Practice ◽  
Administrative Staff ◽  
Technical Application ◽  
Novel Technologies ◽  
Face To Face ◽  
Mixed Methods Case Study ◽  
Online Consultation ◽  
Consultation System ◽  
Access Efficiency

BackgroundThere is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care.AimTo explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices.Design and settingMixed methods case study in an inner-city general practice.MethodThe study was conducted through interviews with IT developers, clinicians, and administrative staff, and scrutiny of documents, websites, and demonstrator versions of Tele-Doc, followed by thematic analysis and discourse analysis.ResultsThree interrelated themes were identified: online consultation systems as innovation, managing the ‘messiness’ of general practice consultations, and redistribution of the work of general practice. These themes raise timely questions about what it means to consult in contemporary general practice. Uptake of Tele-Doc by patients was low. Much of the work of the consultation was redistributed to patients and administrators, sometimes causing misunderstandings. The ‘messiness’ of consultations was hard to eliminate. In-house training focused on the technical application rather than associated transformations to practice work that were not anticipated. GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice.ConclusionTele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs’ workload. Tele-Doc’s potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences.

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

Evaluating the alliance in videolink teletherapy

1997 ◽  
Vol 3 (1_suppl) ◽  
pp. 33-35 ◽  
Author(s):  
G J Ghosh ◽  
P M Mclaren ◽  
J P Watson
Keyword(s):  
Working Alliance ◽  
Psychological Treatment ◽  
Single Case ◽  
Personality Factors ◽  
Control Group ◽  
Face To Face ◽  
Working Alliance Inventory ◽  
The Face

The use of videoconferencing in psychotherapy remains largely unexplored. Videoconferencing compromises the range and quality of interactional information and thus might be expected to affect the working alliance (WA) between client and therapist, and consequently the process and outcome of therapy. A single case study exploring the effect of videoconferencing on the development of the WA in the psychological treatment of a female–male transsexual is described. The self-rated Working Alliance Inventory (WAI) was used to measure client and therapist perceptions of the WA after each session over 10 sessions of eclectic therapy conducted over a videolink. The serial WAI measurements charting the development of the WA in 4 cases of 10-session, face-to-face therapy by Horvath and Marx1 were used as a quasi-control. Therapist and client impressions of teletherapy are described. WAI scores were essentially similar to the face-to-face control group except for lower client-rated bond subscale scores. It is suggested that client personality factors accounted for this difference and that videoconferencing did not impair the development of an adequate working alliance or successful therapeutic outcome.

scholarly journals E-Mail Usage in South Pacific Distance Education

2005 ◽  
pp. 1034-1039
Author(s):  
Jonathan Frank ◽  
Janet Toland ◽  
Karen D. Schenk
Keyword(s):  
Learning Styles ◽  
Research Area ◽  
Web Based ◽  
Group Interactions ◽  
Face To Face ◽  
Web Based Learning ◽  
Active Research ◽  
The Impact ◽  
E Mail ◽  
Active Research Area

The impact of cultural diversity on group interactions through technology is an active research area. Current research has found that a student’s culture appears to influence online interactions with teachers and other students (Freedman & Liu, 1996). Students from Asian and Western cultures have different Web-based learning styles (Liang & McQueen, 1999), and Scandinavian students demonstrate a more restrained online presence compared to their more expressive American counterparts (Bannon, 1995). Differences were also found across cultures in online compared to face-to-face discussions (Warschauer, 1996). Student engagement, discourse, and interaction are valued highly in “western” universities. With growing internationalization of western campuses, increasing use of educational technology both on and off campus, and rising distance learning enrollments, intercultural frictions are bound to increase.

scholarly journals Pengelolaan Keuangan Pemerintah di Masa Pandemi Covid 19 (Kasus Pada Pemerintah Provinsi Riau)

2021 ◽  
Vol 4 (1) ◽  
pp. 33-48
Author(s):  
Yesi Mutia Basri ◽  
Gusnardi Gusnardi
Keyword(s):  
Financial Management ◽  
Sampling Technique ◽  
Provincial Government ◽  
Data Display ◽  
Snowball Sampling ◽  
Key Informants ◽  
The Face ◽  
The Government ◽  
The Impact

This study aims to observe how local government financial management is in the face of the Covid-19 Pandemic—in particular, observing how budgeting, administration, and accountability of the Riau Provincial Government regarding the Covid-19 Pandemic. The research method used is a qualitative method with a type of case study. The data collection techniques used in-depth interviews, observation, and documentation. To ensure the validity of the data, triangulation was carried out by carrying out source triangulation and technical triangulation. The informants in this study consisted of key informants, primary informants, and supporting informants. Key informants are the head of the budget, the head of the treasury, and the head of the accounting and reporting sub-section. While the primary informants and supporting informants were selected using the snowball sampling technique. Data analysis was carried out by collecting data, reducing data display data, and making conclusions. The results of the analysis show that the impact of the Covid-19 Pandemic caused the Riau Provincial Government to refocus and reallocate the budget four times. At the administrative and accountability stages, there are problems with recording Unexpected Expenditures, namely the absence of technical guidelines regarding the administration of Unexpected Expenditures, determining spending limits for emergencies and urgency. Another problem is the absence of valid data for the distribution of aid funds for MSMEs affected by Covid-19 as well as valid documents in the recording of grant assistance from third parties. This research contributes to the government in making policies in financial management in a disaster emergency.Keyword: The Covid-19 Pandemic, Financial Management, Refocusing, Reallocation, Administration, Accountability AbstrakPenelitian ini bertujuan untuk mengobservasi bagaimana pengelolaan keuangan Pemerintah Daerah dalam menghadapi Pandemi Covid-19 ini. Secara khusus mengobservasi bagaimana penganggaran, penatausahaan dan pertanggungjawan Pemerintah Provinsi Riau terkait Pandemi Covid-19. Metode penelitian yang digunakan adalah metode kualitatif dengan jenis studi kasus. Teknik pengumpulan data menggunakan teknik wawancara medalam, observasi dan dokumentasi. Untuk meyakinkan keabsahan data, triangilasi dilakukan dengan melaksanakan triangulasi sumber dan triangulasi teknik. Informan dalam penelitian ini terdiri dari informan kunci, informan utama dan informan pendukung. Informan kunci adalah Kabid anggaran, kabid perbendaharaan dan kasubid akuntansi dan pelaporan. Sedangkan informan utama dan informan pendukung dipilih dengan teknik snowball sampling. Analisis data dilakukan  dengan tahap pengumpulan data, reduksi data display data dan melakukan membuat kesimpulan. Hasil analisis menunjukkan bahwa Dampak Pandemi Covid-19 menyebabkan Pemerintah Provinsi Riau melakukan refocusing dan realokasi anggaran sebanyak empat kali pergeseran anggaran. Pada tahap penatausahaan dan pertanggungjawaban terdapat permasalahan pencatatan pada Belanja Tidak Terduga yaitu tidak adanya juknis tentang penatausahaan Belanja Tidak Terduga, penentuan batasan belanja untuk keadaan darurat dan mendesak.  Permasalahan lainnya yaitu tidak  adanya data yang valid untuk penyaluran dana  bantuan bagi UMKM yang terdampak Covid-19 serta dokumen yang valid dalam pencatatan bantuan hibah dari pihak ke tiga. Penelitian ini memberikan kontribusi kepada pemerintah dalam membuat kebijakan dalam pengelolaan keuangan pada keadaan darurat bencana. Kata Kunci :  Pandemi Covid-19, Pengelolaan Keungan, Refocusing, Realokasi, Penatausahaan, Pertanggungjawaban

scholarly journals The Impact of the Coronacrisis on KIBS Sector

2021 ◽  
Vol 15 (1) ◽  
pp. 6-18
Author(s):  
Ian Miles ◽  
◽  
Veronika Belousova ◽  
Nikolay Chichkanov ◽  
Zhaklin Krayushkina ◽  
...  
Keyword(s):  
Business Services ◽  
Face To Face ◽  
Knowledge Intensive Business Services ◽  
Regulatory Frameworks ◽  
The Face ◽  
Working Practices ◽  
Knowledge Intensive ◽  
Problem Solvers ◽  
Climate Crisis ◽  
The Impact

Knowledge-Intensive Business Services (KIBS) are problem-solvers for other organizations. The coronacrisis affects KIBS directly, but also means that their clients are confronting new problems. How are KIBS addressing these two sets of challenges? This paper draws on material available in the trade and industry press, on official reports and statistics, and the early academic studies addressing these themes. We find that KIBS have been active (alongside other organizations) in providing a substantial range of services aimed at helping their clients (and others) deal with various contingencies thrown up by the crisis. Not least among these is the need to conform to shifting regulatory frameworks, and requirements for longer-term resilience. KIBS themselves have had to adapt their working practices considerably, to reduce face-to-face interaction with clients and within teams collaborating on projects. Adaptation is easier for those whose tasks that are relatively standardized and codified, and it remains to be seen how far a shift to such activities - and away from the traditional office-based venues of activity - is retained as firms recover from the crisis. KIBS are liable to play an important role in this recovery from the crisis, and policymakers can mobilize their services. Some KIBS are liable to be critical for rendering economies more resilient in the face of future pandemics and we argue that these firms are also important for confronting the mounting climate crisis.

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